Differentiated cost shares for drugs and medicinal products

The cost share (copayment) for drugs is essentially 10 per cent of the costs in excess of the annual deductible. If the specialities list contains more than one drug with the same active ingredient or ingredients, the copayment can be up to 20 per cent.

A higher cost share can apply if the patent of a drug has expired and generics are available and contained in the
specialities list. A higher cost share can apply to original preparations, co-marketed drugs and generics.

The copayment for drugs whose ex-factory price exceeds a specific limit is increased to 20 per cent of the costs in excess of the annual deductible.

Drugs subject to a higher copayment are marked with an X on a red background in the “SB” column of the electronic specialities list (available at www.spezialitaetenliste.ch).

Physicians and chiropractors must inform the patient if the specialities list contains one or more generics that can be substituted for an original preparation.

The limit described above is calculated by adding 10 per cent to the average ex-factory price of the cheapest one third of all drugs on the specialities list with the same active ingredient composition. These limits are fixed by the FOPH on 1 December every year, or when the first generic is added to the specialities list.

Predicted limits applicable from 1st December 2023

The limits listed below apply from 1st December 2023. The ex-factory prices are based on the SL data from 1st August 2023. Information on the increased cost share for individual packages may therefore be out of date. For the currently valid cost share the information contained in the SL is always applicable.

Last modification 15.09.2023

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Federal Office of Public Health FOPH
Health and Accident Insurance Directorate
Review of pharmaceuticals Section
Schwarzenburgstrasse 157
3003 Bern
Tel. +41 58 483 96 48

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